| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,642.00 | $3,042.00 | $6,953.00 | |
Aetna
| Facility | 50 | $10,090.50 | $10,090.50 | $10,090.50 |
Anthem BCBS
| Facility | $630.00 | $630.00 | $630.00 | |
Hometown Health
| Professional | $33.22 | $130.01 | $366.66 | |
United
| Facility | $200.00 | $1,754.00 | $3,232.00 |